Health economics of renal replacement therapy: Perspectives from Singapore

Abstract

The prevalence of end-stage renal disease (ESRD) in Singapore is high and projected to increase sharply due to the aging population and the high prevalence of diabetes. The number of patients treated with dialysis was projected to rise from 2633 in 1999 to nearly 6000 in the year 2010. The cost of dialysis provision was estimated to increase 2.5-fold from US dollar 90 million in 1999 to US dollar 241 million in 2010. To address this, the Singapore Ministry of Health launched three initiatives in the year 2000: First, to reduce the incidence of ESRD through (1) primary prevention of diabetes, (2) community-based screening to facilitate early detection of patients with diabetes, (3) improving glycemic and blood pressure (BP) control of diabetics in the primary care setting, and (4) the establishment of dedicated Renal Retardation clinics to optimize BP control (and glycemic control for diabetics), and reduce the level of proteinuria in patients at high risk of ESRD development. Second, to increase the percentage of ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD), which is a lower-cost modality compared with hemodialysis; and third, amendments to the existing opt-out legislation for organ procurement for transplantation to increase the supply of kidneys for cadaveric renal transplant.

Perspectives of Patients, Families, and Health Care Professionals on Decision-Making about Dialysis Modality—the Good, the Bad, and the Misunderstandings!

“…The numbers of patients facing the decision about a dialysis modality are expected to rise even further with the aging of the population and the increased prevalence of diabetes (4)(5)(6)(7).…”

Poor Hemodialysis Outcome Identifying Social Risk Factors in Elderly and Non-elderly Patients in Singapore

“…From the epidemic of ESRD in the general population, another phenomenon of concern has surfaced: the rising incident rate of ESRD among the elderly population. The percentages of patients over the age of 65 years old dialyzing in NKF centers have increased from 16% in 1999 to 22% in 2002 (Tan, Chan, Ho, Wong, Lee, & Woo, 2005). This upward statistics, which was described by Paraskeras, Besslas, Koupidis, Tzivisicov, Milchailidis, and Oreopoulos (2009) to be a "global socioeconomic epidemic, " might be here to stay, given the increasing life Downloaded by [University of Exeter] at 13:08 04 June 2016 expectancy and graying population here and worldwide.…”

Chronic Kidney Disease Prevention in Singapore

“…These clinics focus on the management of patients with established chronic kidney disease (chronic kidney disease stage III-IV). Preliminary findings from the clinic's 817 patients demonstrate better blood pressure control among hypertensive patients, improved glycemic control for diabetics, and significant reduction in proteinuria (1). Published analyses of data from these clinics would be important to follow.…”

“…Singapore's government, in parallel with the NKF Singapore, similarly recognized the increasing burden of ESRD and the need to implement strategies that address this rising demand for dialysis (1). It proposed 3 key strategies, including: 1) an increased focus on prevention of ESRD, 2) using peritoneal dialysis as the preferred renal replacement therapy rather than hemodialysis, and 3) promoting renal transplantation.…”

“…ising rates for end-stage renal disease (ESRD) (1,2), the predicted continued increase in the country's dialysis population because of the aging of its population, and the corresponding increase in the prevalence of chronic disease such as diabetes and hypertension (3,4) led to the development of the National Kidney Foundation of Singapore's (NKF Singapore) Prevention Program in 1997. The NKF Singapore dialyzes nearly 70% of the country's ESRD population (5), which puts it on the direct path for the increased need for dialysis care.…”